Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2019
Use of Hydroxocobalamin (Vitamin B12a) in Patients With Vasopressor Refractory Hypotension After Cardiopulmonary Bypass: A Case Series.
Vitamin B12a (hydroxocobalamin) may be beneficial in managing vasoplegic syndrome following cardiopulmonary bypass.
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Anesthesia and analgesia · Jul 2019
Randomized Controlled TrialHigh-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial.
Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. ⋯ High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.
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Anesthesia and analgesia · Jul 2019
Comparative StudyShould Objective Structured Clinical Examinations Assist the Clinical Competency Committee in Assigning Anesthesiology Milestones Competency?
With the integration of Objective Structured Clinical Examinations into the Anesthesiology primary board certification process, residency programs may choose to implement Objective Structured Clinical Examinations for resident skill assessment. The aim of this study was to evaluate Objective Structured Clinical Examination-based milestone assessment and compare with Clinical Competency Committee milestone assessment that is based purely on clinical evaluations. ⋯ Our analysis confirms the compatibility of the 2 evaluation methods in reflecting longitudinal growth. The deviation of Objective Structured Clinical Examination assessments versus Clinical Competency Committee assessments suggests that Objective Structured Clinical Examinations may be providing additional or different information on resident performance. Educators might consider using both assessment methods to provide the most reliable and valid competency assessments during residency.
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Anesthesia and analgesia · Jul 2019
Prevalence and Multivariable Factors Associated With Preoperative Cognitive Impairment in Outpatient Surgery in the United States.
Preoperative cognitive impairment increases the risk of adverse events after surgery but its prevalence in outpatient surgery has not been defined. We aimed to determine the prevalence and multivariable factors associated with cognitive impairment in individuals who present for outpatient surgery. ⋯ Of 1836 participants who reported having outpatient surgery, we found that 16.1% had evidence of cognitive impairment. Significant multivariable factors associated with preoperative cognitive impairment included non-Hispanic African American race, prior stroke, preoperative functional dependence, and lower socioeconomic status and education level.
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Anesthesia and analgesia · Jul 2019
Randomized Controlled TrialRemote Ischemic Preconditioning Prevents Postoperative Acute Kidney Injury After Open Total Aortic Arch Replacement: A Double-Blind, Randomized, Sham-Controlled Trial.
Why the fuss?
Acute renal injury is a common post-operative complication among high-risk patients and after major surgery, particularly cardiac and major vascular surgery, as is relevant to this study. The clinical relevance of ischaemic preconditioning continues to be controversial.
Even mild post-operative acute kidney injury (AKI) is associated with a wide range of poor perioperative outcomes, and current interventions have struggled to reduce such risk.
What is remote ischaemic preconditioning (RIPC)?
In an effort to protect an at-risk end organ from ischaemia (eg. heart, brain, kidneys), RIPC cyclically induces ischaemia in a remote site (typically an arm using an NIBP cuff). This activates physiological protective mechanisms against hypoxia and reperfusion injury in the target organ. It is cheap, easy and safe.
RIPC as a technique is based upon Murray’s 1986 observations of dog LAD arteries.
Although remote ischaemic (pre)conditioning has been demonstrated in animal models, human studies have been contradictory.
What was done...
This Shanghai research team randomised 130 patients undergoing open aortic arch replacement to receive either remote ischaemic preconditioning (4x 5-min-up 5-min-down) or sham preconditioning.
They found...
Fewer patients demonstrated renal injury at 7 days in the treatment group (55% vs 74%, ARR 95% CI 2-35%), in addition to shortening mechanical ventilation duration (18 vs 25 hours).
Practice changing? No
Although this study has shown a marked reduction in AKI in a uniquely very-high-risk group, as a sole small single-centered study it can barely be applied to the actual study population, let alone generalised to other high-risk groups.
Even when AKI in the control group was a massive 74%, the confidence interval for absolute risk reduction (2-35%) is so wide as to cast doubt on the credibility of this result.
Go deeper:
Meybohm (NEJM 2015), Hausenloy (NEJM 2015), and Menting (Cochrane 2017) failed to show any significant renoprotective effect from RIC in other high-risk groups.
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